title: Age, sex, and cohort effects in a longitudinal study of trachomatous scarring.
abstract: OBJECTIVE
  To determine the 5-year incidence rate of scarring, and associated factors, in the population of Maindi, Tanzania.
  
  
  METHODS
  A census of every resident was obtained at baseline, and ocular examinations for the presence and severity of trachoma were performed. Images of the upper eyelid were taken and graded for the presence and severity of scarring, according to a four-step severity scale based on photographs. Five years after baseline, a second series of images was taken and graded for scarring. Incident scarring was defined as new scars in those without scarring at baseline; progression was defined as those with scars that worsened by one step or more at 5 years.
  
  
  RESULTS
  The rate of scarring at baseline increased with age, from 1% in the <6-year to 38% in the 41+-year age group. Females at any age had more scarring than did males. The 5-year incidence rate of scarring was 0.20 (95% confidence interval [CI], 0.16-0.25), but varied with age up to 0.43 in the 41+-year group. There was a striking cohort effect, with those aged less than 16 years at baseline having more prevalent scarring and incidence rates comparable to those aged 16 to 40. Progression rates averaged 0.47 (95% CI, 0.36-0.58).
  
  
  CONCLUSIONS
  In this trachoma-endemic community, incident scarring was high, especially in the younger cohorts. A dramatic increase in risk of trachomatous scarring occurred approximately 15 years ago and appears to be unabated. Trachoma control programs to reduce risk of scarring are urgently needed to avoid blinding complications in this community.
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Meraf A
authors.initials: MA
authors.lastname: Wolle
authors.forename: Beatriz
authors.initials: B
authors.lastname: Muñoz
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015988:Cohort Effect; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012424:Rural Population; D012737:Sex Factors; D013636:Tanzania / Q000453:epidemiology; D014141:Trachoma / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin